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BDS3 SPECIAL CARE DENTISTRY > Adults With Incapacity Symposium > Flashcards

Adults With Incapacity Symposium Flashcards

1
Q

We must never assume in dentistry, what does this mean?

A
  • everybody treated equally
  • everyone assumed to have capacity unless proven otherwise
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2
Q

what age in scotland are people deemed to have capacity?

A

Age 16 years old
- you can make legally binding decisions for yourself

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3
Q

what is the adults with incapacity act?

A

Framework for safeguarding the welfare and managing the finances of adults who lack capacity due to mental illness, learning disability or a related condition or inability to communicate

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4
Q

who does the adults with incapacity act aim to protect?

A

People who lack capacity to make particular decisions, also to support their involvement in making decisions about their own lives

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5
Q

When does the adults with incapacity act (Scotland) come into action?

A

where an adult is incapable of making a decision for themselves

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6
Q

What part of the Adults with Incapacity act covers medical (including dental) treatment?

A

Part 5

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7
Q

Why is capacity important?

A
  • capacity is key to autonomy (decision making)
  • everyone has the right to say what happens to their own body
  • everyone has the right to say what they dont want to happen to their own body
  • competent adults have the right to refuse treatment
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8
Q

what is the legal definition of incapacity?

A

Inability of an adult to enter into legally binding contracts
- adult means person 16 & over
- an adult with a condition that they cannot understand what a decision involves

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9
Q

how do we assess capacity?

A
  • always presume capacity
  • is it ‘decision’ or ‘action’ specific
  • capacity may fluctuate (not all or nothing)
  • consider residual capacity
  • record your assessment
  • gather evidence from a range of sources & listen carefully to what the patient is telling you
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10
Q

what is meant by the statement: incapacity is not an “all or nothing” event?

A

Capacity can fluctuate throughout the day and course of disease etc.

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11
Q

what is residual capacity?

A

capacity of someone to make simple decisions

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12
Q

When making your assessment of capacity, what is important?

A
  • keep language appropriate
  • break up information into sections (chunk)
  • ask the patient to explain back to you what you have discussed
  • assess retention (ask patient at another appointment)
  • seek advice when needed
  • be open minded & methodical
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13
Q

An adult does not have impaired simply because…:

A
  • they are in care
  • they have a mental health condition
  • they have difficulty with speech or writing
  • they have addiction issues
  • they have a brain injury

ETC.

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14
Q

Who may not have capacity?

A

If a patient has a “mental disorder”
- mental illness, learning disability, dementia, acquired brain injury, autistic spectrum disorder

If a person cannot communicate due to a physical disorder
- locket in syndrome, unconscious following an accident

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15
Q

What are the 5 aspects of being incapacitated?

A
  1. Acting
  2. Making a decision
  3. Communicating decision
  4. Understanding decision
  5. Retaining the memory of decision

AMCUR

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16
Q

what does AMCUR stand for?

A
  1. Acting
  2. Making a decision
  3. Communicating decision
  4. Understanding decision
  5. Retaining the memory of decision
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17
Q

How can difficult communication be aided within the dental practise?

A
  • find out how a person communicates
  • ensure a quiet, will lit environment
  • allow adequate time
  • use technology
  • consider communication adjuncts
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18
Q

what are examples of technology that can help maximise communication?

A
  • loop systems
  • spelling boards
  • ipads
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19
Q

To demonstrate capacity individual should be able to:

A
  • understand in simple language what the treatment is, its purpose and nature & why its being proposed
  • understand its principle benefits, risks & alternatives
  • understand in broad terms what will be the consequences of not receiving the proposed treatment
  • retain the information long enough
20
Q

What are the 5 key principles of the AWI act?

A
  1. benefit
  2. minimum necessary intervention
  3. take account of the wishes of the adult
  4. consultation with relevant others
  5. encourage the adult to exercise ‘residual capacity’
21
Q

What is meant by “benefitting” the patient under the AWI act?

A
  • treatment must benefit the patient
  • without treatment that benefit would not ve possible
  • any intervention must improve or enhance their life
22
Q

Any action or decision taken should be…:

A

The minimum necessary to achieve the purpose
- option that restricts the persons freedoms as little as possible
- always seek to avoid the most invasive treatment if simpler alternatives are available

23
Q

If we are trying to take account of the wishes of the adult (present & past), how can this be done?

A
  • any relatives or close friends who can help us find out?
  • ask the patient
  • look for a patients previous medical/care home notes
  • is their mouth heavily restored? previous investment in dental treatment?
24
Q

Who should we consult in relation to the patient with incapacity’s care?

A
  • nearest relative & primary carer of the adult
  • any guardian, continuing attorney or welfare attorney of the adult who has powers relating to the proposed intervention
  • any person whom the sheriff decides
  • any other person appearing to the person responsible for authorising the intervention
25
Q

why should we encourage residual capacity when making decisions?

A
  • must identify if there are any decisions which the patient can make for themselves
  • encourage the adult to exercise whatever skills they have concerning property, financial affairs or personal welfare
26
Q

what is meant by Proxy?

A

A suitable adult substitute decision maker for someone without capacity?

27
Q

Examples of Proxy?

A
  • power of attorney
  • guardianship orders
28
Q

what are the types of power of attorney?

A
  1. continuing power of attorney
  2. welfare power of attorney
  3. combined power of attorney
29
Q

what are the types of guardianship orders?

A
  • welfare guardian
  • financial guardian
30
Q

what is power of attorney?

A
  • POA is granted while a patient has capacity for someone to act on their behalf should the need arise
  • powers are dormant until needed
  • no expiry date
31
Q

how is power of attorney set up?

A
  • via a lawyer & does not need to go to court
  • ## registered with the Office of the Public Guardian (OPG)
32
Q

what does Continuing Power of Attorney cover?

A

Financial affairs and property
- CANNOT CONSENT TO DENTAL TREATMENT

33
Q

what does welfare power of attorney cover?

A

Welfare decisions including healthcare, dressing, eating etc.
- only come into affect if adult loses capacity
- must take into account adults wishes
- CAN CONSENT TO DENTAL TREATMENT

34
Q

what does combined power of attorney cover?

A

Welfare & financial decisions
- CAN CONSENT TO DENTAL TREATMENT

35
Q

What is the only type of POA that cannot consent dental treatment?

A

Continuing power of attorney

36
Q

who decides on guardianship orders?

A

Court appointed person to make decisions on behalf of an adult with incapacity
- appointed by sheriff after the adult has lost capacity

37
Q

What do guardianship orders require?

A

2 medical reports

38
Q

What do guardianship orders cover?

A

Continuous management of welfare & financial matters
- power to deal with property, finance & even marital affairs

39
Q

How long are guardianship orders valid for?

A

3 years

40
Q

Who can consent for dental treatment?

A
  • patients with capacity
  • welfare powers of attorney
  • welfare guardians
  • Medical & Dental practitioners under section 46 of AWI Act (general authority to treat)
41
Q

If a relative who does not possess welfare powers of attorney or welfare guardian powers, can they consent on behalf of another adult?

A

NOOO

42
Q

Who can issue certificates of incapacity?

A
  • medical practitioner primarily responsible for the patients care
  • consultant in charge of patients care
  • dental practitioners *
  • registered nurses *
  • optometrists *
43
Q

Can dentists automatically give consent under the general authority to treat?

A

Must do a short course & fill out certificate (Section 47 form) in order to be able to do this

44
Q

If a dentist issues a certificate of incapacity, what treatment does that cover?

A

Dental treatment ONLY

45
Q

Is a general dental practitioner able to sign the section 47 form?

A

Unlikely!
- required to liaise with GMP
- GMP should assess capacity of the patient
- If satisfied of incapacity GMP should provide you with an adults with incapacity form
- provide GMP with details to avoid inappropriate generalisation

BDS3 SPECIAL CARE DENTISTRY (14 decks)

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